Metabolic Bone Disease in Premature Neonates: An Unmet Challenge

Abstract

The metabolic bone disease is an important morbidity in premature, very low birth weight and sick infants. If left undiagnosed, leads to structural deformities & spontaneous fractures.It is defined as impaired bone mineralization in a neonate with lower than the estimated bone mineral levels in either fetus or neonate of comparable gestational age / weight coupled with biochemical abnormalities with or without radiological manifestations. It has been reported to occur in 16% to 40% of extremely low birth weight neonates. Insufficient calcium and phosphorous stores during the phase of accelerated growth predispose to it along with use of medications (caffeine, steroids), prolonged parenteral nutrition & chronic immobilization. It presents by 6-16 weeks after birth. Enhanced physical activity in preterm infants facilitates bone mineralization and weight gain. Biochemical abnormalities tend to worsen significantly, as the severity of disease progresses. They consist of hypocalcemia, hypophosphatemia, hyperphosphatasia and secondary hyperparathyroidism. In addition, urinary phosphate wasting and hypo vitaminosis D can complicate these abnormalities. Conversely, biochemical abnormalities may not be accompanied by rachitic changes. Newer diagnostic modalities include bone densitometry by quantitative ultrasound over mid-tibial shaft (noninvasive tool). The management of metabolic bone disease includes adequate calcium, phosphorous and vitamin D supplementation along with optimum nutrition and physical activity. Similarly, preventive strategies for metabolic bone disease should target nutritional enhancement alongside enhanced physical activity. Conclusion: Metabolic bone disease is a preventable morbidity in preterm, VLBW neonates and requires optimum nutritional supplementation and enhanced physical activity.

Overview of Important Micronutrients Supplementation in Preterm Infants after Discharge: A Call for Consensus

“…It has been reported that MBD occurs in 55% of neonates with extremely low birth weight (ELBW ≤ 1000 g birth weight) and 23% of infants with very low birth weight (VLBW < 1500 g). In parallel, it appears to be more frequent in extremely premature babies, born before 28 weeks of gestation [ 51 ]. The mode of feeding and supplementation can also influence the development of MBD.…”

Prevalence of Vitamin D Deficiency Among Infants in Northern India: A Hospital Based Prospective Study

“…The AAP recommends avoiding direct sunlight exposure in infants less than six months of age [15], which can add to vitamin D deficiency [16][17][18]. However, neonates and infants have enhanced ability to produce vitamin D from sunlight when compared to adults due to higher surface area to volume ratio [19,20].…”

Early Nutrition during Hospitalization in Relation to Bone Health in Preterm Infants at Term Age and Six Months Corrected Age

“…Both early postnatal life and the third trimester of the pregnancy are crucial factors for skeletal growth [ 1 , 2 ]. During the last trimester, the fetus has a higher rate of skeletal growth [ 1 ].…”

“…Both early postnatal life and the third trimester of the pregnancy are crucial factors for skeletal growth [ 1 , 2 ]. During the last trimester, the fetus has a higher rate of skeletal growth [ 1 ]. Consequently, preterm infants with a gestational age (GA) below 28 weeks have an increased incidence of impaired skeletal mineralization making them more susceptible to fractures [ 1 , 3 , 4 ].…”

“…During the last trimester, the fetus has a higher rate of skeletal growth [ 1 ]. Consequently, preterm infants with a gestational age (GA) below 28 weeks have an increased incidence of impaired skeletal mineralization making them more susceptible to fractures [ 1 , 3 , 4 ]. The impaired mineralization of the skeleton in premature infants is a result of many nutritional and biochemical factors [ 1 ].…”